In the US there are over 400,000 older adults with end stage renal disease (ESRD), representing the fastest growing age group with this disease. In 2005, 74,864 older adults developed ESRD, while 5,748 underwent kidney transplantation (KT). KT is a relatively new practice in older adults, so little information is available for risk prediction. We recently showed that standard comorbidities captured by kidney and transplant registries are poor predictors in older KT recipients (AUC only 0.66 in a national cohort of 6,988 patients). Our preliminary data supports that factors not captured by registries are needed to improve risk prediction. We hypothesize that a panel of geriatric-specific metrics will improve risk prediction in older KT recipients. Utilizing measures from gerontology literature including frailty, activities of daily living (ADL), instrumental ADL (IADL), and lower extremity disability,is likely to improve outcomes prediction in older KT recipients. Although graft and patient survival are important, older adults strongly value other outcomes, like health-related quality of life (HRQOL). This patient-centered outcome provides a broad summary of how patients perceive their health and has been shown to improve after KT; however in older KT recipients, no studies have documented the natural history of HRQOL or identified risk factors for low HRQOL following KT. Another important KT goal is hospitalization-free survival. Our preliminary data show that while the number of hospitalized days in the first year post-KT was relatively consistent in younger adults, variability was high among older KT recipients. Similar to HRQOL, there are no risk models for hospital-free survival after KT in older adults. To enhance risk prediction in older KT recipients we propose: 1) To quantify the association of geriatric-specific risk metrics and mortality in older KT recipients, 2) To identify predictors of health-related qualty of life in older KT recipients, and 3) To identify predictors of days spent hospitalized in the firt year following KT in older recipients. A better understanding of which older KT recipients will do well after KT, and which will do poorly, is critical for patient selection, counseling, and clinica decision-making.